When you are starting a family it helps to understand the process of conception. Every month a woman releases an egg, this is called ovulation. The egg is transported to the uterus via the Fallopian tubes through contractions and a wafting movement of the hairs lining the tubes. Fertilisation of the egg happens when the egg and sperm meet in the Fallopian tube. Sometimes certain things can disrupt this process delaying successful conception. These things could be abnormalities with the sperm, issues with ovulation or issues in the Fallopian tubes or the uterus. If you are having trouble conceiving, all possible factors should be assessed to be able to diagnose and determine the best treatment or assistance to ensure successful conception.
Fertility in women
The female reproductive system can be complex and fertility issues can sometimes be difficult to understand but once you have the right information, you can start to make the right choices for your family.
Some of the reasons for not being able to conceive could be in:
When there are problems with the ovaries the process of ovulation is disrupted, which can cause infertility or difficulty conceiving. An infection could cause damage to the ovaries. Polycystic Ovarian Syndrome (PCOS) is one of the most common female reproductive system disorders which affects hormone levels, periods, ovulation and fertility. For some women, the onset of menopause could mean less availability of eggs for successful reproduction. Sometimes an imbalance of hormones such as Prolactin or Follicle stimulating hormone can influence how well the ovaries are functioning.
The Fallopian Tubes
The Fallopian Tube is the pathway for both the egg and the sperm take to the uterus. When healthy sperm meets a healthy egg along this tube, the egg is fertilised and moves on to the uterus. But sometimes there can be damage to these tubes or a blockage. The damage often occurs without us even knowing it. Things that can cause damage to the Fallopian tubes could be pelvic infection, previous pelvic surgery, endometriosis (when tissue usually found in the uterus is found outside the uterus which can develop into cysts), a previous ectopic pregnancy (when the egg implants somewhere outside the uterus), and tubal ligation (when the Fallopian tubes have been tied to prevent pregnancy).
There are many reasons why the uterus may not be functioning as effectively as it should when it comes to reproduction. Fibroids, endometrial polyps, foreign bodies such as an intrauterine device, scar tissue, malformations of the uterus that exist since birth and infections such as chronic endometriosis are all common causes of problems in the uterus.
Fertility in older women
As you get older your fertility starts to drop and your chances of getting pregnant decrease.
This doesn’t mean you can’t have a child. For women who are over 35 and are having trouble conceiving, we have various options for you. Speak to our specialists to find out how we can give you your best chances of getting pregnant.
Other reasons you may be having trouble conceiving:
- Diabetes, epilepsy, thyroid problems and bowel diseases
- Medical conditions such as endometriosis and pelvic tuberculosis
- Being overweight, underweight or smoking
- Regular contact with chemicals or radiation
Fertility in men
In about 40% of couples in India looking for assistance in conception, the cause is linked to issues with the man’s sperm.
When it comes to testing for fertility challenges in couples, it is much easier and less invasive to first do a semen analysis to test for problems with the sperm. The test will determine how much semen is produced and provide information on the sperm quality.
A semen analysis is performed to evaluate the health and viability of sperm. Three major factors are measured:
1 The number of sperm (sperm count/density)
2 The shape of the sperm (50%+ should be normal)
3 The movement of the sperm (50%+ should move normally)
pH level, sperm volume, liquefaction and appearance should also be normal. If sperm are abnormal, they will have trouble reaching and/or penetrating the egg, which makes conception challenging. Further tests can also be recommended by your fertility specialist including genetic tests, hormone testing, urinalysis after ejaculation, testicular biopsy and antisperm immune cells testing.
At Miracle Clinic, we understand that fertility challenges, or possible male infertility, is a private matter and we therefore treat each case with the utmost confidentiality. We can assist with sperm collection, analysis and selection for improved pregnancy chances.
We recommend TrueFertility for Men. It is the first and most accessible step towards diagnosing fertility challenges. Men and women can be assessed separately, but because infertility generally affects both partners, we recommend that they are both present.
What can cause male infertility?
- Genetic conditions such as Klinefelter’s syndrome. We test for these conditions if there is a family history or a complete lack of sperm shows in a sample.
- Hormones affecting normal sperm production
- Most infections will not cause infertility, but an infection that is left untreated could damage the tubes that transport sperm. This could lead to azoospermia, a condition in which there is an absence of sperm in semen.
- Azoospermia or no sperm count in the semen
Some other reasons you may be having trouble conceiving:
- Inflammation of the testes
- Prior invasive medical treatment such as radiotherapy, surgery or medication
- Being overweight, underweight or smoking
- Regular contact with chemicals or radiation
What happens when there is no cause diagnosed?
Not having a definite answer can be frustrating but most men with abnormal semen fall into this category. It is still possible to reproduce but if success has not been achieved within three years, advanced reproductive technology is available for you and your family.
We can help you find the right treatment whatever your situation:
- You have been trying to conceive for a short period of time
- You are not ovulating
- You are ovulating but still haven’t conceived
- There are some complications with your sperm
- You both want a natural pregnancy but need some assista
You’ve been trying for a family for a while now. You may be worried. You may have seen a doctor about it in the past or this may be your first attempt to find out why you are struggling to get pregnant. Our only objective as a fertility centre is to assist you by establishing the reasons for the challenge and to provide you with a solution to ensure you get the chance of having a family of your own.
- General fertility assessments
- Reassurance and personalised advice
- A number of fertility treatment procedures
- Free counselling
Facing the challenges and decisions that need to be made and which are associated with medical assistance in getting pregnant isn’t easy. We have seen the impact of family and societal pressure on couples and we have witnessed what these pressures do to a marriage. To help you, and to ensure you are emotionally supported each step of the way, we provide free counselling throughout your treatment at Bridge Clinic Fertility Centre.
The easiest way to identify the cause of your challenge is through a series of assessments. Our specialists are trained to perform only the most necessary evaluations and to rule out any obvious reasons for your challenges. As these assessments are more specialised, your treatment options are narrowed down to ensure that the treatment that you receive is most suitable to your specific challenge. Once we can identify the cause of the challenge, we can help you make the right choice.
The first thing to determine is whether or not you can conceive naturally. Sometimes all your body needs in order for you to get pregnant is a bit of help from a medical professional.
Fertility drugs remain the primary treatment for women with ovulation disorders. Some are taken orally and some are injected. In general, these medications work by causing the release of hormones that either trigger or regulate ovulation. If you have a hormone imbalance, we will need to identify this and then determine which fertility drug is best for you.
There are a range of medications and medical drugs available for you depending on your condition.
Having irregular periods, no periods, or abnormal bleeding often indicates that you aren’t ovulating, a condition known clinically as anovulation. Although anovulation can usually be treated with fertility drugs, it is important to be evaluated for other conditions that could interfere with ovulation, such as thyroid conditions or abnormalities of the adrenal or pituitary glands. This is why it is important to diagnose or rule out this potential cause of your fertility problem.
An ovulation problem occurs when eggs don’t mature in the ovaries or when the ovaries fail to release a mature egg. Possible symptoms include absent or infrequent periods, unusually light or heavy menstrual bleeding, or lack of such premenstrual symptoms such as bloating or breast tenderness. Possible solutions include managing body weight if it’s too low or too high and taking fertility drugs.
Uterine fibroids are benign (noncancerous) growths of the muscular wall of the uterus. Fibroids can impact fertility if they grow inside of the uterus. They change the environment of the uterus in a way that can interfere with embryo implantation or predispose a woman to have early miscarriages. We will identify this as a potential barrier to your pregnancy and treat the fibroids appropriately, usually with surgery.
An ovarian cyst is a fluid-filled sac that forms in the ovary. Ovarian cysts are common and, in the vast majority of cases, they are benign (non-cancerous) in patients younger than 35.
Ovarian cysts affect fertility if they interfere with normal ovulation or represent a mechanical obstacle for the fertilisation process. We will determine the nature of any cysts you may have, as well as how they should be treated. In some cases it may be necessary to remove cysts surgically.
A fallopian tube blockage typically prevents successful passage of the egg to the sperm or the fertilised egg to the uterus. Surgery can be used to try to correct this common cause of infertility. The specific type of surgery depends on the location and extent of the fallopian tube blockage. Success rates for tubal surgery usually vary by the location of the blockage and even when it goes well, there are usually risks of adhesions post-surgery. To reduce your time to pregnancy, our specialists may offer IVF as an alternative treatment option to circumvent tubal problems.
Can a previous abortion affect your chances of getting pregnant? Probably not. However, in rare cases, multiple dilations and curettages (the cleaning out of the uterus, also known as a D&C) can cause scarring at the top of the cervix or inside the uterus. A procedure called hysteroscopy (when a small camera is placed through your cervix into your uterine cavity) can check for this problem and usually repair the scar tissue at the same time.
There are a number of common and some less common medical conditions that are specific to our female patients. These conditions should not be the cause of your fertility challenges if they are treated with care and managed properly. Occasionally we have found that this is not the case and that these conditions do have a direct impact on the woman’s ability to conceive. Treating these medical conditions first often assists patients to conceive naturally, however, specialist care is occasionally required to assist women to conceive when these conditions are more serious.
Polycystic ovary syndrome (PCOS) is a condition that affects the woman’s ovaries, the reproductive organs that produce oestrogen and progesterone. These hormones regulate the menstrual cycle. Women with PCOS produce higher-than-normal amounts of male hormones. These hormones cause imbalances in the body, causing women with PCOS to skip menstrual periods or may make it harder for them to get pregnant.
When the abdomen is injured because of disease or surgery, adhesions can form. Adhesions are bands of scar tissue that can form between abdominal organs (uterus, fallopian tubes, ovaries, or bowel) and/or between these organs and the wall of the abdomen.
Depending on their location, adhesions may make it difficult for you to get pregnant or can cause bowel obstruction or pain. If you experience any of these conditions, your doctor might suspect that you have adhesions. Laparoscopic surgery is required to diagnose and treat adhesions.
Premature ovarian decline refers to a loss of normal function of your ovaries before age 40. If your ovaries fail, they don’t produce normal amounts of the hormone oestrogen or release eggs regularly. Premature ovarian failure is sometimes referred to as premature menopause, but the two conditions aren’t exactly the same. Women with premature ovarian failure may have irregular or occasional periods for years and may even become pregnant. Women with premature menopause stop having periods and can’t become pregnant. Restoring oestrogen levels in women with premature ovarian failure helps prevent some complications, such as osteoporosis, but infertility is harder to treat.
Endometriosis is a medical condition that occurs when the lining of the uterus, called the endometrium, grows in other places such as the fallopian tubes, ovaries or along the pelvis. When that lining breaks down, like the regular lining in the uterus that produces the menstruation, it has nowhere to go. This causes cysts, heavy periods, severe cramps and even infertility. Although endometriosis impairs fertility, it does not usually completely prevent conception.
A laparoscopy is a minor surgical procedure that involves your doctor putting a thin scope into your abdomen to view your pelvic organs. This procedure will be able to diagnose if you have endometriosis.
Pelvic inflammatory disease (PID) is an infection of the reproductive organs of a woman. The pelvis is in the lower abdomen and includes the fallopian tubes, the ovaries, the cervix, and the uterus.
Several different types of bacteria can cause PID, including the same bacteria that cause the sexually transmitted infections (STIs) gonorrhoea and chlamydia. What commonly occurs is that bacteria first enter the vagina and cause an infection. As time passes, this infection can move into the pelvic organs. PID can become extremely dangerous, even life-threatening, if the infection spreads to your blood. If you suspect that you may have an infection, see your doctor as soon as possible.
Once we are certain that none of the ‘primary care’ treatments above are applicable to you, we will start looking at specialist care options. These treatments are a lot more specific than the ‘primary care’ treatments, and we will only embark on this journey once we are absolutely sure none of the other procedures are relevant. This will ensure that you don’t waste money on a specialist care treatment when a ‘primary care’ treatment is what you really need. Let’s analyse the specialist care options that are available, should you need them.
Intrauterine insemination (IUI) is a fertility treatment that uses a catheter to place a number of washed sperm directly into the uterus. The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilisation and is a relatively “low-tech” assisted reproductive technology (ART). The IUI procedure is simple and may be performed even if the woman is not receiving medication to improve or increase her egg production. However, many physicians will encourage women to take medication to stimulate the ovaries in order to increase egg production and, hopefully, the chance of getting pregnant.
As one of the leading fertility centres in India, we have a detailed understanding of all forms of IVF, so we can help you find the best option for your family. By fertilising the eggs outside of the body, your chances of getting pregnant are much greater. Through simple and pain-free procedures, we collect your eggs or those of a donor. These eggs are then fertilised using a sperm sample from your husband or a donor. We then allow these fertilised eggs a chance to grow into blastocysts before a maximum of 2 are introduced into your uterus where they can grow into a healthy baby.
Please take note: Miracle Advanced Reproductive Centre does not offer conventional IVF and all IVF procedures use ICSI or IMSI to ensure a higher chance of getting pregnant.
Your IVF options
Intracytoplasmic Sperm Injection is a procedure that has revolutionised the treatment of male infertility. During this procedure, a single sperm is injected directly into the partner’s egg. As a result, men with a failed vasectomy reversal or with a congenital (from birth) absence of the vas deferens now have a high chance of fatherhood without using donor sperm. This procedure has decreased the need for donor sperm and almost eliminated the concept of untreatable male infertility. ICSI may be performed due to failed fertilisation with conventional IVF or male infertility such as low count, low motility and poor quality of sperm.
Intracytoplasmic Morphologically-selected Sperm Injection is a laboratory technique used in IVF treatments. IMSI is a real-time method where sperms are selected before the microinjection takes place. This is done using an inverted microscope that is able to provide a much greater magnifying power (around 6000 times) than those that are normally used in reproductive laboratories. With this microscope, we can see the internal morphology of sperm and discard those with abnormalities. Being able to select sperm without morphological alterations is believed to increase the chances of successful implantation of pre-embryo and decrease the likelihood of miscarriage.
Recent advances in blastocyst culture and transfer have resulted in improved IVF pregnancy rates and reduced multiple pregnancy rates. Traditionally, embryos are transferred to the uterus on day three after fertilisation and it is not uncommon to transfer three or four embryos. However, it is now possible to grow embryos in the laboratory to the blastocyst stage of development, which occurs on day five after fertilisation. Typically, the strongest, healthiest embryos make it to blastocyst stage as they have survived key growth and division processes and have a better chance of implanting once transferred. The selection of potentially more viable embryos allows the embryologist to transfer fewer embryos, often one or two, lowering the risk of high order multiples while maintaining high pregnancy rates.
Fertility Preservation Treatments
Whether it is for your first child or second, we give you the choice of freezing your spare embryos through a process of vitrification.
Recurring pregnancy loss is the occurrence of three or more consecutive pregnancy losses and occurs in 15-20 percent of all pregnancies. A pregnancy loss is defined as a clinically recognised (confirmed by ultrasound or pregnancy tissue) pregnancy that has involuntarily ended before 20 weeks. This does not mean that you are unable to bear children, and we can identify possible causes and solutions to give you the optimal solution for bearing a child. Even after having 3 miscarriages, a woman has a 60-80 percent chance of conceiving and carrying a full-term pregnancy.
By choosing to have eggs or sperm donated, either by someone you know or an anonymous donor, you have the chance to enjoy a full, healthy pregnancy.
Egg donation is the process by which a younger woman donates eggs for purposes of assisted reproduction. Egg donation typically involves in vitro fertilisation (IVF), with the eggs being fertilised by the partner’s sperm in the laboratory. Eggs from donors may also be stored for later use.
Sperm from donors can be used for donor insemination (DI) or IVF to help the woman become pregnant. Sperm donors are screened for sexually transmitted diseases and some genetic disorders. In DI, sperm from the donor is placed into the neck of the womb (cervix) at the time when the woman ovulates. It is important we obtain consent from both parties before the use of donor sperm, except for single ladies.
Many couples are not able to have their own children, regardless of having a normal sperm or ovarian function, due to congenital absence of the uterus or malformations of the reproductive tract. In some instances, a pregnancy may be contraindicated due to other health issues that jeopardise the life of the mother, or because the medical treatment will expose the foetus to the teratogenic effect of medicines taken during pregnancy.
With IVF surrogacy we collect your healthy eggs, fertilise them with your husband’s sperm and transfer the embryos into a surrogate womb for healthy development. The uterus of the gestational carrier will be synchronised with the ovulation induction of the biological mother in order to create the best possible environment for the embryo. A complete psychological evaluation and numerous blood screening tests are required, as well as a signed legal agreement among all involved.
Cryopreservation is a cooling technique for freezing reproductive tissue in liquid nitrogen to a temperature of -196 ° C. Frozen sperm, oocytes and embryos do not age and allows us to store reproductive tissue for many years. In infertility planning, cryopreservation can be used at different stages and for different reasons.
There are two known techniques used for cryopreservation; slow-freezing and vitrification. At Bridge Clinic Fertility Centre, we choose vitrification because of the known high success rate.
Vitrification is a sophisticated cryopreservation technique based on fast freezing of reproductive tissue within seconds. It uses a medium containing cryoprotectants, protecting cells against damage.
Vitrification of gametes and embryos is performed using modern processes in an enclosed system. In contrast to slow-freezing, this system allows an increase in the success rate of fertility treatment using frozen gametes and embryos almost to the level of success achieved with fresh samples.
Success of Cryopreservation
At Bridge Clinic, we vitrify quality embryos at the blastocyst stage (day 5 or 6 of cultivation), which guarantees up to 98% success of survival of such embryos.
Oocyte cryopreservation has shown similar high success rates of live birth. Bridge Clinic Fertility Centre recorded the first live birth by oocyte vitrification in 2016 in Nigeria.
Advantages of cryopreservation
- Gametes and embryos can be stored for future use
- Eliminates the risk of ovarian hyperstimulation
- It reduces the risks associated with multiple egg collections
- It improves cost efficiency of additional treatment cycles
Cryopreservation of oocytes (eggs)
Vitrification of oocytes (eggs) is, thanks to vitrification, a standard part of infertility treatment. According to international studies, vitrification of eggs does not affect clinical pregnancy and does not increase the risk of having a child with a congenital defect.
When is oocyte vitrification used?
- In the event of imminent failure of ovarian function, it allows patients to preserve their own eggs for future use.?
- In case of an imminent loss of fertility due to cancer treatment. Vitrification of eggs offers women of childbearing age before treatment of cancer to maintain the hope of getting pregnant when their disease is under control.
- In case of unexpected absence of partner’s sperm in IVF treatment cycle. If, on the day of collection of eggs from a stimulated patient, it is not possible to obtain any sperm from the partner (for reasons of health, transport, work or temporary psychological state), the obtained eggs can be frozen.
- Also, if during a surgical sperm collection from the testicle (MESA-TESE) no sperm is found and the infertile couple does not want to opt for use of donor sperm, the collected oocytes can be frozen. Both partners gain time for consideration of possible solutions and the final decision on the type of treatment.
- Another option for the use of vitrification is the freezing of eggs in young women of childbearing age who do not currently have a partner and fear that by the time they have a partner their fertility might be impaired. Also women who do not plan on getting pregnant immediately and for reasons of study or employment procrastinate the term conception can have their eggs frozen.
Frozen Embryo Transfer
Freezing the embryo gives couples more options in planning their family and reduces the cost of subsequent assisted pregnancies. Freezing embryos for subsequent transfer may be advised for women who are about to undergo chemotherapy or radiation therapy for cancer or other diseases. Frozen Embryo Transfer effectively doubles the chances of conception, and is a far more cost effective option than a standard second cycle of In Vitro Fertilization.
Your final treatment fee will vary depending on the treatment plan designed for you by your fertility specialist. The fees below serve as guidance only and we recommend that you discuss these with your specialist.